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Yamaguchi A, Ishitobi M, Nagura N, Shimo A, Seki H, Ogiya A, Sakurai T, Seto Y, Oshiro C, Sasada S, Kato M, Kawate T, Kondo N, Narui K, Nakagawa T, Nogi H, Yamauchi C, Tsugawa K, Kajiura Y, Shien T. Classification of Local Recurrence After Nipple-Sparing Mastectomy Based on Location: The Features of Nipple-Areolar Recurrence Differ from Those of Other Local Recurrences. Ann Surg Oncol 2023; 30:1678-1686. [PMID: 36371582 DOI: 10.1245/s10434-022-12760-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/17/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Little information is available about the clinical and pathologic characteristics of local recurrence (LR) after nipple-sparing mastectomy according to the locations of LR. METHODS This study classified 99 patients into the following two groups according to the location of LR after nipple-sparing mastectomy: nipple-areolar recurrence (NAR) group and other locations of LR (oLR) group. The study evaluated whether the location of LR was associated with disease-free survival (DFS) after LR resection. RESULTS For about half of the patients (44.4 %) with NAR, the primary cancer was estrogen receptor (ER)-negative and human epidermal growth factor receptor 2 (HER2)-positive. Conversely, in most of the patients with oLR (79.2 %), the primary cancer was ER-positive and HER2-negative. Among the LR tumors, the frequency of noninvasive carcinoma in the NAR tumors was significantly higher than in the oLR tumors (51.9 % vs 4.2 %, respectively). During a median follow-up period of 46 months, the location of LR was not associated with DFS after LR. In the NAR group, the presence or absence of LR tumor invasiveness was the only factor associated with DFS. In the oLR group, age at primary surgery was the only factor associated with DFS. CONCLUSION This multi-institutional retrospective study demonstrated that the features of NAR, such as the characteristics of the primary and recurrent tumors and the prognostic factors after LR resection, were quite different from those of oLR.
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Affiliation(s)
- Ayu Yamaguchi
- Department of Breast Surgery, Mie University School of Medicine, Mie, Japan
| | - Makoto Ishitobi
- Department of Breast Surgery, Mie University School of Medicine, Mie, Japan.
| | - Naomi Nagura
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Ayaka Shimo
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kanagawa, Japan.,Department of Breast and Endocrine Surgery, Kawasaki Municipal Tama Hospital, Kanagawa, Japan
| | - Hirohito Seki
- Department of Breast Surgery, Saitama Medical Center, Saitama, Japan
| | - Akiko Ogiya
- Department of Breast Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Yukiko Seto
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Chiya Oshiro
- Department of Breast Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Shinsuke Sasada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Michiko Kato
- Department of Breast Surgical Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Takahiko Kawate
- Department of Breast Surgery and Oncology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Naoto Kondo
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazutaka Narui
- Department of Breast and Thyroid Surgery, Medical Center, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Tsuyoshi Nakagawa
- Department of Breast Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroko Nogi
- Department of Breast and Endocrine Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Chikako Yamauchi
- Department of Radiation Oncology, Shiga General Hospital, Shiga, Japan
| | - Koichiro Tsugawa
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yuka Kajiura
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
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2
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Lee J, Kang BJ, Park GE, Kim SH. The Usefulness of Magnetic Resonance Imaging (MRI) for the Detection of Local Recurrence after Mastectomy with Reconstructive Surgery in Breast Cancer Patients. Diagnostics (Basel) 2022; 12:diagnostics12092203. [PMID: 36140604 PMCID: PMC9497711 DOI: 10.3390/diagnostics12092203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/04/2022] [Accepted: 09/07/2022] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study is to investigate the usefulness of magnetic resonance imaging (MRI) for the detection of local recurrence after nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) with immediate reconstructive surgery for breast cancer. Two hundred and eighty-six NSM or SSM procedures and immediate reconstruction cases between August 2015 and February 2020 were reviewed. The detectability rates of for local recurrence using MRI and ultrasound were assessed, and the characteristics of recurrent and primary cancers were evaluated. The patients with multifocal or multicentric primary cancer and a dense parenchymal pattern showed a higher recurrence rate (p < 0.001). A total of 22 cases showed recurrence, and due to multifocal recurrence, a total of 27 recurrent lesions were identified in the reconstructed breast, of which 12 were symptomatic and 15 were asymptomatic (p < 0.001). With the exception of skin recurrence (n = 6), MRI showed a significantly higher detectability rate (95.2%, 20 of 21) than ultrasound (38.1%, 8 of 21) for the recurrence of cancer in the reconstructed breast (p < 0.001), especially for small-sized (<1 cm) asymptomatic lesions. In addition, the mean recurrence interval of MRI-detected asymptomatic lesions was 21.7 months (SD ± 17.7), which was significantly longer than that of symptomatic recurrence. In conclusion, postoperative MRI can be useful for identifying small-sized (<1 cm) asymptomatic recurrence lesions in reconstructed breast tissue after NSM or SSM, which can be implemented within two years of surgery.
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Crystal J, Mella-Catinchi J, Xu K, Weingrad D. Current Surgical Innovations in the Treatment of Breast Cancer. Breast Cancer 2022. [DOI: 10.36255/exon-publications-breast-cancer-surgical-innovation] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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4
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Arzanova E, Mayrovitz HN. Male Breast Cancer: Treatment Trends, Reported Outcomes, and Suggested Recommendations. Cureus 2021; 13:e18337. [PMID: 34725599 PMCID: PMC8555756 DOI: 10.7759/cureus.18337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 12/13/2022] Open
Abstract
Male breast cancer (MBC) is unfamiliar to most men, and its optimal treatment options are not well recognized by many treating physicians. The lack of MBC specific clinical trials contributes to the limitations of understanding MBC specific pathology, treatment options, and outcomes. This state-of-affairs contribute to perpetuating the use of treatment methods derived from our existing knowledge of female breast cancer (FBC). Previous studies demonstrate that men are often undertreated or disproportionately treated using more invasive surgical procedures even in the early stages of MBC. The purpose of this investigation was to thoroughly discuss current MBC treatment options, provide an evidence-based summary of their outcomes, note recent improvements, discuss important considerations and recommendations. Our goal is to aid the treatment decision process for patients and treating physicians.
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Affiliation(s)
- Evelina Arzanova
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Harvey N Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
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5
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Xie F, Wang S. Clinical practice guideline of BRCA1/2 testing for patients with breast cancer: Chinese Society of Breast Surgery (CSBrS) practice guideline 2021. Chin Med J (Engl) 2021; 134:1516-1518. [PMID: 34091527 PMCID: PMC8280056 DOI: 10.1097/cm9.0000000000001587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Fei Xie
- Department of Breast Center, Peking University People's Hospital, Beijing 100044, China
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6
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Collins JM, Isaacs C. Management of breast cancer risk in BRCA1/2 mutation carriers who are unaffected with cancer. Breast J 2020; 26:1520-1527. [PMID: 32652823 DOI: 10.1111/tbj.13970] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 11/30/2022]
Abstract
Pathogenic mutations in BRCA1 and BRCA2 genes markedly increase the risk of breast cancer and other cancers such as ovarian/fallopian tube, pancreatic, prostate, and melanoma. Patients with BRCA1 mutations have a slightly higher lifetime risk of breast cancer than BRCA2 mutation carriers, and both BRCA1 and BRCA2 carriers tend to develop breast cancer at an earlier age than the general population. In this review, we will discuss management recommendations to reduce breast cancer risk for BRCA1/2 mutation carriers including special populations of carriers such as pregnant or lactating patients and men. Breast cancer screening, including clinical breast examination, mammogram, and breast MRI, is important for detecting breast cancer at an early and likely curable stage. In addition to screening, counseling on risk-reducing surgeries is strongly recommended for BRCA1/2 carriers. Risk-reducing mastectomy decreases the risk of breast cancer development, and risk-reducing salpingo-oophorectomy decreases ovarian cancer-specific as well as overall mortality, but controversy exists regarding its impact on breast cancer-specific mortality. Given the effectiveness of screening for breast cancer, further management should be carried out on an individual basis taking into account quality of life and psychosocial factors, and recommendations should be readdressed periodically as science progresses and patients' goals may change.
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Affiliation(s)
- Julie M Collins
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
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7
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Wang M, Huang J, Chagpar AB. Can I Keep My Nipple? Factors Influencing the Surgical Decision between Skin-Sparing and Nipple-Sparing Mastectomy. Am Surg 2020. [DOI: 10.1177/000313481908500741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Both skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) are well accepted in the management of breast cancer. Factors that influence the decision of choosing one of these techniques over the other, however, remain to be well elucidated. From January 2010 to December 2017, 734 patients at our institution underwent one of these two procedures. Factors differentiating these patient cohorts were compared. In this study, 196 (26.7%) underwent NSM and 538 (73.3%) underwent SSM. The median age of patients at the time of surgery was 50 years (range, 22–78 years). On multivariate analysis, younger patient age, insurance type, BRCA1 mutation status, smaller breast size (by weight), and those who did not undergo neoadjuvant chemotherapy were more likely to undergo NSM. Surgeon also was an independent predictor of whether patients had NSM or SSM. There may be many factors that play into the decision to pursue NSM versus SSM, but younger patient age, BRCA mutation status, breast size, and whether the patient had neoadjuvant chemotherapy may be key among them. Insurance status may also be a factor for some patients. Aside from these factors, some surgeons may be more or less inclined to perform NSM.
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Affiliation(s)
- Melinda Wang
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Julian Huang
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Anees B. Chagpar
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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8
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Paluch-Shimon S, Cardoso F, Partridge AH, Abulkhair O, Azim HA, Bianchi-Micheli G, Cardoso MJ, Curigliano G, Gelmon KA, Harbeck N, Merschdorf J, Poortmans P, Pruneri G, Senkus E, Spanic T, Stearns V, Wengström Y, Peccatori F, Pagani O. ESO-ESMO 4th International Consensus Guidelines for Breast Cancer in Young Women (BCY4). Ann Oncol 2020; 31:674-696. [PMID: 32199930 DOI: 10.1016/j.annonc.2020.03.284] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/07/2020] [Indexed: 12/16/2022] Open
Abstract
The 4th International Consensus Conference for Breast Cancer in Young Women (BCY4) took place in October 2018, in Lugano, Switzerland, organized by the European School of Oncology (ESO) and the European Society of Medical Oncology (ESMO). Consensus recommendations for the management of breast cancer in young women were updated from BCY3 with incorporation of new evidence to inform the guidelines. Areas of research priorities were also identified. This article summarizes the ESO-ESMO international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).
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Affiliation(s)
| | - F Cardoso
- Breast Unit Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - A H Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - O Abulkhair
- King Abdulaziz Medical City for National Guard, Riyadh, Saudi Arabia
| | - H A Azim
- School of Medicine, Monterrey Institute of Technology, Monterrey, MX
| | | | - M-J Cardoso
- Breast Unit Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Nova Medical School Lisbon, Portugal
| | - G Curigliano
- European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - K A Gelmon
- British Columbia Cancer, Vancouver, Canada
| | - N Harbeck
- Breast Center, Dept. OB&GYN, University of Munich (LMU), Munich, Germany
| | | | - P Poortmans
- Institut Curie, Department of Radiation Oncology & Paris Sciences & Lettres - PSL University, Paris, France
| | - G Pruneri
- National Cancer Institute, IRCCS Foundation, Milan, Italy
| | - E Senkus
- Medical University of Gdansk, Gdansk, Poland
| | - T Spanic
- Europa Donna Slovenia, Ljubljana, Slovenia
| | - V Stearns
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, USA
| | - Y Wengström
- Department of Neurobiology Cancer Science and Society, Karolinska Institute and Theme Cancer Karolinska University Hospital, Sweden
| | - F Peccatori
- European Institute of Oncology IRCCS & European School of Oncology, Milan, Italy
| | - O Pagani
- Oncology Institute of Southern Switzerland and Breast Unit of Southern Switzerland, Geneva University Hospitals, Swiss Group for Clinical Cancer Research (SAKK), Bellinzona, Switzerland
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9
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Wang M, Huang J, Chagpar AB. Is nipple sparing mastectomy associated with increased complications, readmission and length of stay compared to skin sparing mastectomy? Am J Surg 2020; 219:1030-1035. [DOI: 10.1016/j.amjsurg.2019.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/26/2019] [Accepted: 09/10/2019] [Indexed: 11/26/2022]
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10
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Barbieri E, Frusone F, Bottini A, Sagona A, Gatzemeier W, Canavese G, Anghelone CAP, De Luca A, Marrazzo E, Amabile MI, Tinterri C. Evolution and time trends of nipple-sparing mastectomy: a single-center experience. Updates Surg 2020; 72:893-899. [PMID: 32449032 DOI: 10.1007/s13304-020-00796-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/09/2020] [Indexed: 01/27/2023]
Abstract
Nipple Sparing Mastectomy (NSM) requires the entire breast tissue to be removed, maintaining the nipple-areola complex, and represents nowadays the gold standard of the demolitive breast surgery. Although it represents the evolution of conservative breast surgery, NSM presents some limitations in the selection of women candidates for treatment, and still there are no real guidelines regarding its indications, but simply objective data to address the choice. How the breast surgery approach to demolitive and conservative surgery has changed over time? We evaluated throughout the years (from 2009 up to 2018) the time trend of NSM at our institution and analysed the main differences between patients undergone NSM and other mastectomies and/or breast conserving surgery in terms of cancer size, multicentricity and biological profile. We found 781 NSMs, 1261 other mastectomies and 5621 breast conservative surgeries. Among NSMs, 39.6% were reconstructed with tissue expander and 58.1% with definitive prosthesis. From 2009 to 2018 we found a general increase of NSM rate (from 21.3% of all mastectomies in 2009 to 67.3% in 2018) and a decrease of total mastectomies (from 78.7% of all mastectomies in 2009 to 32.7% in 2018). In line with the literature data, our data confirm that in the recent years NSM represents the gold standard for radical breast surgery. Undisputed in prophylaxis, NSM is continuously acquiring more support in being used as first line treatment for locally advanced disease.
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Affiliation(s)
- Erika Barbieri
- Breast Surgery Department, Humanitas Research Hospital and Cancer Center, Rozzano, Milan, Italy
| | - Federico Frusone
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
| | - Alberto Bottini
- Breast Surgery Department, Humanitas Research Hospital and Cancer Center, Rozzano, Milan, Italy
| | - Andrea Sagona
- Breast Surgery Department, Humanitas Research Hospital and Cancer Center, Rozzano, Milan, Italy
| | - Wolfgang Gatzemeier
- Breast Surgery Department, Humanitas Research Hospital and Cancer Center, Rozzano, Milan, Italy
| | - Giuseppe Canavese
- Breast Surgery Department, Humanitas Research Hospital and Cancer Center, Rozzano, Milan, Italy
| | | | - Alessandro De Luca
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Emilia Marrazzo
- Breast Surgery Department, Humanitas Research Hospital and Cancer Center, Rozzano, Milan, Italy
| | - Maria Ida Amabile
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Corrado Tinterri
- Breast Surgery Department, Humanitas Research Hospital and Cancer Center, Rozzano, Milan, Italy
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11
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Karanlik H, Igci A. Surgical Approach in Invasive Breast Cancer. Breast Cancer 2019. [DOI: 10.1007/978-3-319-96947-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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Rose JF, Zavlin D, Lim SJ, Spiegel AJ, Chevray PM, Albright SB, Friedman JD. Nipple viability after nipple-sparing mastectomy in patients with prior circum-areolar incisions. Breast J 2018; 24:1028-1034. [PMID: 30066416 DOI: 10.1111/tbj.13103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 12/01/2022]
Abstract
Nipple-areola-sparing mastectomy (NSM) is becoming more commonplace as it offers a more esthetic breast appearance while still appropriately treating malignancy. However, patients with prior circum-areolar incisions are often considered at risk for nipple viability. The authors present a case series of all patients undergoing NSM at their institution between 2012 and 2016. Eighteen consecutive female nonsmoking patients underwent 32 NSMs. None of the patients had reconstructive failures including those relating to the nipple-areola complex (NAC), such as nipple necrosis. NSM is therefore feasible in cases with prior circum-areolar incisions. These patients can be safely reconstructed with both prosthetic devices and autologous tissue.
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Affiliation(s)
- Jessica F Rose
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Dmitry Zavlin
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Sherry J Lim
- Department of Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Aldona J Spiegel
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Pierre M Chevray
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Steven B Albright
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Jeffrey D Friedman
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
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13
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Paluch-Shimon S, Cardoso F, Sessa C, Balmana J, Cardoso MJ, Gilbert F, Senkus E. Prevention and screening in BRCA mutation carriers and other breast/ovarian hereditary cancer syndromes: ESMO Clinical Practice Guidelines for cancer prevention and screening. Ann Oncol 2018; 27:v103-v110. [PMID: 27664246 DOI: 10.1093/annonc/mdw327] [Citation(s) in RCA: 245] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- S Paluch-Shimon
- Division of Oncology and the Dr Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
| | - C Sessa
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - J Balmana
- Vall d`Hebron University Hospital Institut d'Oncologia, Barcelona, Spain
| | - M J Cardoso
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
| | - F Gilbert
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
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14
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Radovanovic Z, Ranisavljevic M, Radovanovic D, Vicko F, Ivkovic-Kapicl T, Solajic N. Nipple-Sparing Mastectomy with Primary Implant Reconstruction: Surgical and Oncological Outcome of 435 Breast Cancer Patients. Breast Care (Basel) 2018; 13:373-378. [PMID: 30498425 DOI: 10.1159/000489317] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background This study aimed to examine the incidence of surgical complications associated with nipple-sparing mastectomy (NSM) with primary implant reconstruction, analyze risk factors for early and late surgical complications of NSM, and determine the incidence of local recurrences and the safety of sparing the nipple-areola complex (NAC). Methods This retrospective cohort study included 435 patients with 441 NSM procedures over a period of 9 years (2004-2012). All surgical complications and the oncological outcome were recorded during follow-up. Results The most common early surgical complication was skin flap ischemia/necrosis (26 patients, 5.9%). Prosthesis explantation due to complications was carried out in 11 (2.5%) cases. Neoadjuvant chemotherapy, implant size >500 ml, diabetes mellitus, body mass index > 25 kg/m2, and incisions other than lateral were risk factors for early complications (p < 0.001). The NAC excision rate was 5.4% (24 cases) due to confirmed presence of cancer cells in the subareolar tissue. Capsular contracture as a late complication occurred in 33 (7.48%) cases. Local relapse occurred in 32 (7.3%) patients. Distant metastases were diagnosed in 68 (15.6%) patients, and 53 (12.2%) patients died during the follow-up period. Conclusions NSM with immediate implant reconstruction has an acceptable morbidity rate and is an oncologically and surgically appropriate treatment for most women requiring mastectomy.
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Affiliation(s)
- Zoran Radovanovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Milan Ranisavljevic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Dragana Radovanovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Ferenc Vicko
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Tatjana Ivkovic-Kapicl
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Nenad Solajic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
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15
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Lee SB, Lee JW, Kim HJ, Ko BS, Son BH, Eom JS, Lee TJ, Ahn SH. Long-term outcomes of patients with breast cancer after nipple-sparing mastectomy/skin-sparing mastectomy followed by immediate transverse rectus abdominis musculocutaneous flap reconstruction: Comparison with conventional mastectomy in a single center study. Medicine (Baltimore) 2018; 97:e0680. [PMID: 29718895 PMCID: PMC6393080 DOI: 10.1097/md.0000000000010680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To evaluate the oncological outcomes of patients with breast cancer after nipple-sparing mastectomy (NSM)/skin-sparing mastectomy (SSM), followed by immediate reconstruction, as compared to conventional mastectomy (CM).SSM/NSM has been increasingly used to treat women with breast cancer who wish to preserve the overlying breast skin, but concern exist regarding its oncological safety due to the potential for residual breast tissue. We report our experience performing SSM/NSM for breast cancer treatment compared to CM with a long follow-up period.All consecutive patients who underwent mastectomy for breast cancer at Asan Medical Center between January 1993 and December 2008 were identified by retrospective medical chart review. The patients who underwent NSM/SSM, followed by immediate breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap (TRAM), were compared to the patients who underwent CM in terms of breast-cancer specific survival (BCSS) rate, distant metastasis-free survival (DMFS) rate, and local recurrence (LR) rate.During the study period, 6028 patients underwent mastectomy for breast cancer. Of these, 1032 and 4996 underwent NSM/SSM with TRAM and CM, respectively. Their median follow-up durations were 94.4 (range, 8.1-220.2) and 110.8 (range, 6.1-262.0) months, respectively. Their 5 year BCSS rates were 95.4% and 88.1%, respectively (log-rank, P < .001). Their 5 year DMFS rates were 93.0% and 85.6%, respectively (log-rank, P < .001).Relative to CM, NSM/SSM, followed by immediate breast reconstruction, may be a viable and oncologically safe surgical treatment in selected patients with breast cancer.
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Affiliation(s)
- Sae Byul Lee
- Division of Breast and Endocrine Surgery, Department of Surgery
| | - Jong Won Lee
- Division of Breast and Endocrine Surgery, Department of Surgery
| | - Hee Jeong Kim
- Division of Breast and Endocrine Surgery, Department of Surgery
| | - Beom Seok Ko
- Division of Breast and Endocrine Surgery, Department of Surgery
| | - Byung Ho Son
- Division of Breast and Endocrine Surgery, Department of Surgery
| | - Jin Sup Eom
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Taik Jong Lee
- Department of Plastic Surgery, Boryeong Asan Medical Center, Boryeong, Korea
| | - Sei-Hyun Ahn
- Division of Breast and Endocrine Surgery, Department of Surgery
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Paluch-Shimon S, Pagani O, Partridge AH, Abulkhair O, Cardoso MJ, Dent RA, Gelmon K, Gentilini O, Harbeck N, Margulies A, Meirow D, Pruneri G, Senkus E, Spanic T, Sutliff M, Travado L, Peccatori F, Cardoso F. ESO-ESMO 3rd international consensus guidelines for breast cancer in young women (BCY3). Breast 2017; 35:203-217. [DOI: 10.1016/j.breast.2017.07.017] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022] Open
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Endoscopic Delayed Breast Reconstruction With Expanders and Implants via the Axillary Incision Made for Sentinel Lymph Node Biopsy or Lymphadenectomy. Ann Plast Surg 2017; 80:100-103. [PMID: 28930777 DOI: 10.1097/sap.0000000000001208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Classic techniques of delayed prosthetic breast reconstruction use the mastectomy scar as an access route. As a result, the filling of the expander must be postponed until the wounds have healed. This creates an asymmetry between the breasts with the volume changes caused by the filling of the expander, which may occur over several weeks and cause considerable discomfort. METHODS Delayed breast reconstruction was performed via the axillary incision made for sentinel lymph node biopsy or lymphadenectomy with endoscopic assistance and detachment of the pectoralis major muscle. The filling of the expander and symmetrization with the contralateral breast was performed in the first stage.The expander was replaced with the definitive prosthesis 3 months later, after endoscopic capsulotomy. Fat grafting was performed to create a lipobed around the implant and to improve tissue quality. RESULTS Sixty-two patients underwent surgery. Mean follow-up was 19 months. There were no major complications in the reconstructed breast. One case of hematoma in a contralateral breast reduction and an oil cystic mass secondary to fat grafting were recorded. In all cases, the filling of the expander with the definitive volume was possible during the first stage. CONCLUSIONS Endoscopic delayed breast reconstruction with insertion of implants through the axillary incision for sentinel node biopsy or lymphadenectomy is safe and feasible. It achieves complete intraoperative expansion, symmetry between the volumes of the breasts during the first stage, and avoids problems with the scar and the risk of extrusion, as the scar is placed remotely in the axilla.
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Militello G, De Marco P, Falco N, Kabhuli K, Mascolino A, Licari L, Tutino R, Cocorullo G, Gulotta G. Is it really useful the Harmonic scalpel in axillary dissection for locally advanced breast cancer? A case series. G Chir 2017; 37:262-265. [PMID: 28350973 DOI: 10.11138/gchir/2016.37.6.262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The seroma is one of the most common complications in the axillary lymph nodal dissection (different surgical approaches have been tried to reduce the seroma incidence). In our study we evaluate the outcome of patients using or not the ultrasonic scalpel (Harmonic scalpel) according to a standardized surgical technique. PATIENTS AND METHODS From January 2011 to December 2015 120 patients underwent axillary dissection for breast cancer. Patients were divided in two groups: patients belonging to the first group underwent Harmonic scalpel dissection and patients belonging to the second group underwent classical dissection. Each group consisted of 60 patients. Quadrantectomy (QUAD) was performed in 54 patients, 66 women underwent mastectomy. In all patients axillary dissection included the I, II and III level. We compared two groups in terms of: time of surgery, hematoma, drainage volume, days of sealing drainage, seroma formation, number of post-seroma aspirations, upper limb lymphedema, wound infections, post-operative pain. RESULTS Statistically significant results were obtained in terms of the total volume of the breast and axillary drainage in the two techniques. There were no significant differences in the two samples in terms of operative time incidence of seroma, post-operative hematoma, wound infection, and lymphedema of the upper limb. CONCLUSION The small number of cases did not allow us to reach definitive conclusions. The use of Harmonic scalpel seems to show smaller incidence of seroma and reduction of the amount of both breast and axillary drainages. Further studies are needed to define the real advantage in terms of cost benefit of using these devices in the axillary surgery.
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Mota BS, Riera R, Ricci MD, Barrett J, de Castria TB, Atallah ÁN, Bevilacqua JLB. Nipple- and areola-sparing mastectomy for the treatment of breast cancer. Cochrane Database Syst Rev 2016; 11:CD008932. [PMID: 27898991 PMCID: PMC5868722 DOI: 10.1002/14651858.cd008932.pub3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of breast cancer are still questionable. It is estimated that the local recurrence rates following nipple-sparing mastectomy are very similar to breast-conserving surgery followed by radiotherapy. OBJECTIVES To assess the efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of ductal carcinoma in situ and invasive breast cancer in women. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialized Register, the Cochrane Center Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Embase (via OVID) and LILACS (via Biblioteca Virtual em Saúde [BVS]) using the search terms "nipple sparing mastectomy" and "areola-sparing mastectomy". Also, we searched the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov. All searches were conducted on 30th September 2014 and we did not apply any language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) however if there were no RCTs, we expanded our criteria to include non-randomised comparative studies (cohort and case-control studies). Studies evaluated nipple-sparing and areola-sparing mastectomy compared to modified radical mastectomy or skin-sparing mastectomy for the treatment of ductal carcinoma in situ or invasive breast cancer. DATA COLLECTION AND ANALYSIS Two review authors (BS and RR) performed data extraction and resolved disagreements. We performed descriptive analyses and meta-analyses of the data using Review Manager software. We used Cochrane's risk of bias tool to assess studies, and adapted it for non-randomised studies, and we evaluated the quality of the evidence using GRADE criteria. MAIN RESULTS We included 11 cohort studies, evaluating a total of 6502 participants undergoing 7018 procedures: 2529 underwent a nipple-sparing mastectomy (NSM), 818 underwent skin-sparing mastectomy (SSM) and 3671 underwent traditional mastectomy, also known as modified radical mastectomy (MRM). No participants underwent areola-sparing mastectomy. There was a high risk of confounding for all reported outcomes. For overall survival, the hazard ratio (HR) for NSM compared to SSM was 0.70 (95% CI 0.28 to 1.73; 2 studies; 781 participants) and the HR for NSM compared to MRM was 0.72 (95% CI 0.46 to 1.13; 2 studies, 1202 participants). Local recurrence was evaluated in two studies, the HR for NSM compared to MRM was 0.28 (95% CI 0.12 to 0.68; 2 studies, 1303 participants). The overall risk of complications was different in NSM when compared to other types of mastectomy in general (RR 0.10, 95% CI 0.01 to 0.82, 2 studies, P = 0.03; 1067 participants). With respect to skin necrosis, there was no evidence of a difference with NSM compared to other types of mastectomy, but the confidence interval was wide (RR 4.22, 95% CI 0.59 to 30.03, P = 0.15; 4 studies, 1948 participants). We observed no difference among the three types of mastectomy with respect to the risk of local infection (RR 0.95, 95% CI 0.44 to 2.09, P = 0.91, 2 studies; 496 participants). Meta-analysis was not possible when assessing cosmetic outcomes and quality of life, but in general the NSM studies reported a favourable aesthetic result and a gain in quality of life compared with the other types of mastectomy. The quality of evidence was considered very low for all outcomes due to the high risk of selection bias and wide confidence intervals. AUTHORS' CONCLUSIONS The findings from these observational studies of very low-quality evidence were inconclusive for all outcomes due to the high risk of selection bias.
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Affiliation(s)
- Bruna S Mota
- Instituto do câncer de São Paulo (ICESP/FMUSP)Department of Obstetrics and GynecologyAv. Dr Arnaldo 251Sao PauloSao PauloBrazil01246‐000
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilSão PauloBrazil
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilSão PauloBrazil
| | - Marcos Desidério Ricci
- Instituto do câncer de São Paulo (ICESP/FMUSP)Department of Obstetrics and GynecologyAv. Dr Arnaldo 251Sao PauloSao PauloBrazil01246‐000
| | - Jessica Barrett
- University Forvie Site, Robinson WayMRC Biostatistics Unit, Institute of Public HealthCambridgeUKCB2 0SR
- University of Cambridge, Strangeways Research LaboratoryCardiovascular Epidemiology Unit, Department of Public Health and Primary CareWort’s CausewayCambridgeUKCB1 8RN
| | - Tiago B de Castria
- Instituto do Câncer do Estado de São Paulo (ICESP/FMUSP)Clinical OncologyAv. Doutor Arnaldo 251 ‐ Cerqueira CésarSão PauloBrazil01246‐000
| | - Álvaro N Atallah
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilSão PauloBrazil
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Wei CH, Scott AM, Price AN, Miller HC, Klassen AF, Jhanwar SM, Mehrara BJ, Disa JJ, McCarthy C, Matros E, Cordeiro PG, Sacchini V, Pusic AL. Psychosocial and Sexual Well-Being Following Nipple-Sparing Mastectomy and Reconstruction. Breast J 2016; 22:10-7. [PMID: 26782950 DOI: 10.1111/tbj.12542] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Nipple-sparing mastectomy (NSM) is considered an oncologically safe option for select patients. As many patients are candidates for nipple-sparing or skin-sparing mastectomy (SSM), reliable patient-reported outcome data are crucial for decision-making. The objective of this study was to determine whether patient satisfaction and/or health-related quality of life (HRQOL) were improved by preservation of the nipple with NSM compared to SSM and nipple reconstruction. Subjects were identified from a prospectively maintained database of patients who completed the BREAST-Q following mastectomy and breast reconstruction between March and October 2011 at Memorial Sloan Kettering Cancer Center. Fifty-two patients underwent NSM followed by immediate expander-implant reconstruction. A comparison group consisted of 202 patients who underwent SSM followed by immediate expander-implant reconstruction and later nipple reconstruction. HRQOL and satisfaction domains as measured by BREAST-Q scores were compared in multivariate linear regression analyzes that controlled for potential confounding factors. NSM patients reported significantly higher scores in the psychosocial (p = 0.01) and sexual well-being (p = 0.02) domains compared to SSM patients. There was no significant difference in the BREAST-Q physical well-being, satisfaction with breast, or satisfaction with outcome domains between the NSM and SSM groups. NSM is associated with higher psychosocial and sexual well-being compared to SSM and nipple reconstruction. Preoperative discussion of such HRQOL outcomes with patients may facilitate informed decision-making and realistic postoperative expectations.
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Affiliation(s)
- Cindy H Wei
- Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amie M Scott
- Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison N Price
- Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Helen Catherine Miller
- Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne F Klassen
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sabrina M Jhanwar
- Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph J Disa
- Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Colleen McCarthy
- Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evan Matros
- Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter G Cordeiro
- Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Virgilio Sacchini
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrea L Pusic
- Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Lee TJ, Oh TS, Kim EK, Suh H, Ahn SH, Son BH, Lee JW, Cho J, Eom JS. Risk factors of mastectomy skin flap necrosis in immediate breast reconstruction using low abdominal flaps. J Plast Surg Hand Surg 2016; 50:302-6. [PMID: 27121604 DOI: 10.3109/2000656x.2016.1170026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of this study was to determine the risk factors associated with mastectomy skin flap necrosis during immediate reconstruction with TRAM or DIEP flaps. METHODS This study reviewed 1116 cases of immediate breast reconstruction over 10 years. Patients ranged in age from 29-76 years (average = 45.1 years), and had an average follow-up period of 65.6 months. Thirteen factors (age, BMI (body mass index), smoking habits, diabetes ptosis grade, midclavicle-to-nipple distance, neoadjuvant chemotherapy, free or pedicled flap, mastectomy method, surgeon, stage, axillary dissection, mastectomy weight) known to be associated with mastectomy flap necrosis were retrospectively analysed. The odds ratios of the risk factors were calculated using logistic regression analyses. RESULTS Mastectomy skin flap necrosis occurred in 247 cases (22.1%). Univariate regression analysis showed that the odds ratio of age, BMI, ptosis grade, midclavicle-to-nipple distance, free flap, mastectomy method, surgeon, stage, and mastectomy weight were significant and the odds ratios determined using multivariate analysis were significant for mastectomy method, surgeon, and mastectomy weight. CONCLUSION During breast reconstruction using abdominal tissue, the independent risk factors that affect mastectomy skin flap necrosis include the mastectomy method, surgeon, and the weight of the mastectomy specimen. Awareness of the impact of each risk factor will lead to the modification and individualisation of surgical techniques and continually improve outcomes.
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Affiliation(s)
- Taik Jong Lee
- a Department of Plastic Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea
| | - Tae Suk Oh
- a Department of Plastic Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea
| | - Eun Key Kim
- a Department of Plastic Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea
| | - Hyunsuk Suh
- a Department of Plastic Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea
| | - Sei Hyun Ahn
- b Department of Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea
| | - Byung Ho Son
- b Department of Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea
| | - Jong Won Lee
- b Department of Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea
| | - Jonghan Cho
- c Seoul Plastic Surgery Clinic , Gangneung , Gangwon-do , South Korea
| | - Jin Sup Eom
- a Department of Plastic Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea
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Paluch-Shimon S, Pagani O, Partridge AH, Bar-Meir E, Fallowfield L, Fenlon D, Friedman E, Gelmon K, Gentilini O, Geraghty J, Harbeck N, Higgins S, Loibl S, Moser E, Peccatori F, Raanani H, Kaufman B, Cardoso F. Second international consensus guidelines for breast cancer in young women (BCY2). Breast 2016; 26:87-99. [DOI: 10.1016/j.breast.2015.12.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/19/2015] [Indexed: 11/12/2022] Open
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Huang NS, Wu J. Nipple-sparing Mastectomy in Breast Cancer: From an Oncologic Safety Perspective. Chin Med J (Engl) 2016; 128:2256-61. [PMID: 26265622 PMCID: PMC4717986 DOI: 10.4103/0366-6999.162500] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To evaluate the oncologic safety of nipple-sparing mastectomy (NSM) for breast cancer patients based on current literature. Data Sources: A comprehensive literature search of Medline, Embase databases was conducted for studies published through March 2014. Study Selection: Our search criteria included English-language studies that focused on NSM at nipple-areola complex (NAC) involvement, patient selection, and recurrence. Prophylaxis NSM, case series or reports that based on very small population were excluded. In the end, 42 studies concerning NSM and oncological safety were included into the review. Results: NSM is a surgical procedure that allows the preservation of the skin and NAC in breast cancer patients or in patients with prophylactic mastectomy. However, the oncologic safety and patient selection criteria associated with NSM are still under debate. The incidence of NAC involvement of breast cancer in recent studies ranges from 9.5% to 24.6%, which can be decreased through careful patient selection. Tumour-nipple distance, tumour size, lymph node involvement and molecular characteristics can be evaluated preoperatively by clinical examinations, imaging studies and biopsies to predict the risk of NAC involvement. Currently, there is no available standard protocol for surgical approaches to NSM or pathological examination of NSM specimens. The local recurrence (ranges from 0% to 24%) of NSM is not significantly higher than that of traditional mastectomy in selected patients based on long-term follow-up. The role of radiotherapy in NSM is still controversial and is not universally accepted. Conclusions: NSM appears to be oncologically safe following careful patient selection and assessment of margins.
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Affiliation(s)
| | - Jiong Wu
- Department of Breast Surgery, Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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Abstract
Breast conservative therapy (BCT) is established as a safe option for most women with early breast cancer (BC). The best conservative mastectomy that can be performed, when mastectomy is unavoidable, is nipple-areola-complex sparing mastectomy (NSM), which allows the complete glandular dissection preserving the skin envelope and the nipple areola complex. In the treatment of BC, the cosmetic outcomes have become fundamental goals, as well as oncologic control. NSM is nowadays considered an alternative technique to improve the overall quality of life for women allowing excellent cosmetic results because it provides a natural appearing breast. The breast surgeon must pay attention to details and skin incision must be planned to minimize vascular impairment to the skin and the nipple. Preservation of the blood supply to the nipple is one of the most important concern during NSM because nipple or areolar necrosis is a well-described complication of this surgery. Another issue associated with the nipple preservation and the surgical technique is oncological safety related to nipple-areola-complex (NAC) involvement in patients with invasive BC. The authors present their experience on 252 NSM performed in the Breast Surgery Unit in Forlì. Careful selection of patients for this surgical procedure is imperative and many patients are not ideal candidates for this procedure because of concerns about nipple-areolar viability as women with significant large/ptotic breast, pre-existing breast scars and history of active cigarette smoking. To extend the benefits of nipple preservation to patients who are perceived to be at higher risk for nipple necrosis the authors describe technical modifications of NSM to allow nipple preservation and obtain good cosmetic outcomes.
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Affiliation(s)
- Camilla Rossi
- Breast Surgery Unit, G.B. Morgagni-Pierantoni Hospital, AUSL della Romagna sede di Forlì (FC), Via Carlo Forlanini, 34. 47100 Forlì, Italy
| | - Matteo Mingozzi
- Breast Surgery Unit, G.B. Morgagni-Pierantoni Hospital, AUSL della Romagna sede di Forlì (FC), Via Carlo Forlanini, 34. 47100 Forlì, Italy
| | - Annalisa Curcio
- Breast Surgery Unit, G.B. Morgagni-Pierantoni Hospital, AUSL della Romagna sede di Forlì (FC), Via Carlo Forlanini, 34. 47100 Forlì, Italy
| | - Federico Buggi
- Breast Surgery Unit, G.B. Morgagni-Pierantoni Hospital, AUSL della Romagna sede di Forlì (FC), Via Carlo Forlanini, 34. 47100 Forlì, Italy
| | - Secondo Folli
- Breast Surgery Unit, G.B. Morgagni-Pierantoni Hospital, AUSL della Romagna sede di Forlì (FC), Via Carlo Forlanini, 34. 47100 Forlì, Italy
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Abstract
Conservative mastectomies provide removal of the entire breast parenchyma, saving the outer covering of the mammary gland with the possibility of performing an immediate reconstruction preserving women body image. We rationalised and systematically organized our reconstructive algorythms giving a new different light to mastectomies, the so-called "conservative mastectomies", an oxymoron indicating skin-sparing mastectomies (SSM), nipple-areola complex-sparing mastectomies (NSM) and skin-reducing mastectomies (SRM). Eventhough randomized controlled trials comparing conservative mastectomies with traditional mastectomy and breast conserving surgery would be auspicable in order to achieve higher levels of evidence, we could confidently conclude that conservative mastectomies offer the psychological advantages of good cosmesis and maintenance of woman body image without compromising the oncological safety of mastectomy.
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Affiliation(s)
- Maurizio Bruno Nava
- 1 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana, Milano, Italy ; 2 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S.Pansini 5, 80131 Naples, Italy ; 3 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy
| | - Nicola Rocco
- 1 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana, Milano, Italy ; 2 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S.Pansini 5, 80131 Naples, Italy ; 3 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy
| | - Giuseppe Catanuto
- 1 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana, Milano, Italy ; 2 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S.Pansini 5, 80131 Naples, Italy ; 3 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy
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Abstract
INTRODUCTION Besides the diffusion of breast reconstructive techniques, several "conservative" approaches in mastectomy have been developed, in order to perform an immediate reconstruction with better aesthetic results: the skin-sparing mastectomy (SSM), the nipple-areola complex (NAC)-sparing mastectomy (NSM) and the skin-reducing mastectomy (SRM). During the last decade, SSMs and NSMs have gained widespread acceptance and are currently considered standard treatment for early breast cancer. We would like to investigate the evidence behind this radical shift towards conservative mastectomies, where there has been a renewed interest worldwide. METHODS We reviewed English literature by consulting the following databases: Medline, Embase, Cochrane Register of Controlled Trials, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal and Clinicaltrials.gov. The objective is to include any randomized controlled trial (RCT) comparing a "conservative mastectomy" technique to breast conservative surgery or modified radical mastectomy (MRM) for the treatment of early-stage breast cancer. In the absence of randomized trials, we took into account prospective cohorts and retrospective series for a narrative description of available evidence. RESULTS Our review included 58 studies [19 prospective cohorts (34%) and 39 retrospective series (66%)] considering NSM and immediate reconstruction and ten studies [1 prospective cohort (10%) and 9 (90%) retrospective series] considering SSM and immediate reconstruction. In the NSM group, 29 studies reported data about complication rates and 42 studies presented data on NAC partial or complete necrosis. In the NSM group 45 studies and all the studies in the SSM group presented data on local and NAC recurrence. CONCLUSIONS In order to achieve higher levels of evidence, RCTs comparing conservative mastectomies to traditional mastectomy and breast conservative surgery would be desirable. However we can conclude that conservative mastectomies offer the psychological advantages of good cosmetics and maintenance of woman body image without compromising the oncological safety of mastectomy.
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Affiliation(s)
- Nicola Rocco
- 1 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy ; 2 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy ; 3 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana 4, 20122 Milano, Italy
| | - Giuseppe Catanuto
- 1 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy ; 2 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy ; 3 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana 4, 20122 Milano, Italy
| | - Maurizio Bruno Nava
- 1 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy ; 2 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy ; 3 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana 4, 20122 Milano, Italy
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JANSSEN STEFAN, HOLZ-SAPRA EDNA, RADES DIRK, MOSER ALEXANDER, STUDER GABRIELA. Nipple-sparing mastectomy in breast cancer patients: The role of adjuvant radiotherapy (Review). Oncol Lett 2015; 9:2435-2441. [PMID: 26137086 PMCID: PMC4473656 DOI: 10.3892/ol.2015.3084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 02/19/2015] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to evaluate the role of adjuvant radiotherapy (RT) following nipple-sparing mastectomy (NSM) for patients with ductal carcinoma in situ and invasive breast cancer, based on the published literature. Currently, there is no standard for RT following NSM. NSM aims to spare the nipple areola complex (NAC) without compromising locoregional control. Long-term follow-up studies have begun to show promising results. A search of the English literature was performed using the Medline database and Cochrane central library, with the keywords 'nipple/areola-sparing mastectomy', 'whole skin mastectomy' and 'NAC preservation'. A total of 32 original studies with data on NSM in terms of locoregional control, NAC control, NAC necrosis and adjuvant RT were identified. The median locoregional and NAC recurrence rates were 3.2 and 1.4% (range, 0-28.4% and 0-3.7%), respectively. The volume of remaining breast tissue following NSM was reported inconsistently. In 15 studies, RT was not mentioned. In the remaining 17 studies, RT was administered in 0-100% of patients. Only 7 studies provided detailed information regarding the use of adjuvant RT. Adjuvant thoracic wall irradiation was not used in certain studies, not even for locoregionally advanced tumors. Overall, NSM appears a feasible treatment without increased risk of locoregional recurrence for selected patients. The role of adjuvant RT following NSM requires further clarification. The decision regarding adjuvant RT must be made in interdisciplinary tumor boards and with consideration of the individual situation of the patient.
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Affiliation(s)
- STEFAN JANSSEN
- Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
- Department of Radiation Oncology, University of Luebeck, Luebeck, Germany
| | - EDNA HOLZ-SAPRA
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - DIRK RADES
- Department of Radiation Oncology, University of Luebeck, Luebeck, Germany
| | - ALEXANDER MOSER
- Department of Gynecology and Obstetrics, Nordstadt Hospital, Hannover, Germany
| | - GABRIELA STUDER
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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Predictive factors of nipple involvement in breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2015; 151:239-49. [PMID: 25893590 DOI: 10.1007/s10549-015-3385-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 04/11/2015] [Indexed: 10/23/2022]
Abstract
Nipple-sparing mastectomy (NSM) provides a cosmetic and psychological benefit for patients, but concerns on nipple involvement (NI) of tumor continue to persist. Several studies have reported factors for predicting NI, but the results were inconsistent and uncomprehensive, making patient selection difficult. The aim of the systematic review was to pool the published data to further discern factors associated with NI. A literature review was conducted of PubMed database, following the PRISMA guidelines. Relative risks (RRs) and 95 % confidence intervals (CIs) were calculated using random-effect or fix-effect model. Publication bias and Chi-square test were also calculated. From 1978 to 2014, 27 clinical studies with 7971 patients met the inclusion criteria. Predictive factors suggest higher rates of NI including the following: tumor-to-nipple distance (TND) ≤ 2.5 cm (3.65, 1.42-9.33); positive lymph node status (2.09, 1.71-2.57); stage III or IV disease (2.41, 1.93-3.00); tumor size > 5 cm (2.42, 1.95-3.02); estrogen receptor (ER)-negative status (1.19, 1.01-1.40); progesterone receptor (PR)-negative status (1.52, 1.25-1.84); HER-positive status (1.76, 1.46-2.12); patients with ductal carcinoma in situ (DCIS) compared with invasive ductal carcinoma (1.55, 1.16-2.08). Due to the statistical heterogeneity detected with certain parameters, further investigations to confirm their association with NI will be needed. Patients with one or more risk factors such as centrally located tumors; higher tumor stage; large tumors; ER-negative/PR-negative/HER-positive status and associated DCIS have higher risk of NI. Taking these factors into consideration comprehensively may help with decision-making process for NSM.
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Margolis NE, Morley C, Lotfi P, Shaylor SD, Palestrant S, Moy L, Melsaether AN. Update on imaging of the postsurgical breast. Radiographics 2015; 34:642-60. [PMID: 24819786 DOI: 10.1148/rg.343135059] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Oncologic, reconstructive, and cosmetic breast surgery has evolved in the last 20 years. Familiarity with cutting-edge surgical techniques and their imaging characteristics is essential for radiologic interpretation and may help avert false-positive imaging findings. Novel surgical techniques include skin- and nipple-sparing mastectomies, autologous free flaps, autologous fat grafting, and nipple-areola-complex breast reconstruction. These techniques are illustrated and compared with conventional surgical techniques, including modified radical mastectomy and autologous pedicled flaps. The role of magnetic resonance (MR) imaging in surgical planning, evaluation for complications, and postsurgical cancer detection is described. Breast reconstruction and augmentation using silicone gel-filled implants is discussed in light of the Food and Drug Administration's recommendation for MR imaging screening for "silent" implant rupture 3 years after implantation and every 2 years thereafter. Recent developments in skin incision techniques for reduction mammoplasty are presented. The effects of postsurgical changes on the detection of breast cancer are discussed by type of surgery.
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Affiliation(s)
- Nathaniel E Margolis
- From the Department of Radiology, Breast Imaging Section, New York University School of Medicine, Langone Medical Center, 550 First Ave, New York, NY 10016
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Lemaine V, Hoskin TL, Farley DR, Grant CS, Boughey JC, Torstenson TA, Jacobson SR, Jakub JW, Degnim AC. Introducing the SKIN score: a validated scoring system to assess severity of mastectomy skin flap necrosis. Ann Surg Oncol 2015; 22:2925-32. [PMID: 25634782 DOI: 10.1245/s10434-015-4409-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND With increasing use of immediate breast reconstruction (IBR), mastectomy skin flap necrosis (MSFN) is a clinical problem that deserves further study. We propose a validated scoring system to discriminate MSFN severity and standardize its assessment. METHODS Women who underwent skin-sparing (SSM) or nipple-sparing mastectomy (NSM) and IBR from November 2009 to October 2010 were studied retrospectively. A workgroup of breast and plastic surgeons scored postoperative photographs using the skin ischemia necrosis (SKIN) score to assess depth and surface area of MSFN. We evaluated correlation of the SKIN score with reoperation for MSFN and its reproducibility in an external sample of surgeons. RESULTS We identified 106 subjects (175 operated breasts: 103 SSM, 72 NSM) who had ≥1 postoperative photograph within 60 days. SKIN scores correlated strongly with need for reoperation for MSFN, with an AUC of 0.96 for SSM and 0.89 for NSM. External scores agreed well with the gold standard scores for the breast mound photographs with weighted kappa values of 0.82 (depth), 0.56 (surface area), and 0.79 (composite score). The agreement was similar for the nipple-areolar complex photographs: 0.75 (depth), 0.63 (surface area), and 0.79 (composite score). CONCLUSIONS A simple scoring system to assess the severity of MSFN is proposed, incorporating both depth and surface area of MSFN. The SKIN score correlates strongly with the need for reoperation to manage MSFN and is reproducible among breast and plastic surgeons.
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Affiliation(s)
- Valerie Lemaine
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA,
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The Austrian breast implant register: recent trends in implant-based breast surgery. Aesthetic Plast Surg 2014; 38:1109-15. [PMID: 25320030 DOI: 10.1007/s00266-014-0407-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Due to the fact that the number of breast implant surgeries for cosmetic and medical purposes is rising yearly, a discussion about the quality of service for both patients and physicians is more important than ever. To this end, we reviewed the Austrian Breast Implant Register with one specific question in mind: What are the trends? MATERIALS AND METHODS In the statistical analysis of the Austrian Breast Implant Register, we were able to identify 13,112 registered breast implants between 2004 and 2012. The whole dataset was then divided into medical and cosmetic groups. We focused on device size, surface characteristics, filling material, device placement and incision site. All factors were considered for all examined years. RESULTS In summary, the most used device had a textured surface (97 %) and silicone gel as the filling material (93 %). The mean size of implants for the cosmetic group was 240 cc, placement was submuscular (58 %) and the incision site was inframammary (67 %). In the medical group, the mean size was 250 cc. Yearly registrations had their peak in 2008 (1,898 registered devices); from this year on, registrations decreased annually. A slight trend away from subglandular placement in the cosmetic group was noted. Also, the usage of implants with polyurethane surface characteristics has increased since 2008. The smooth surface implants had a peak usage in 2006 and their usage decreased steadily from then on whereas the textured surface was steady over the years. DISCUSSION AND CONCLUSION Keeping the problems related to the quality of breast implants in mind, we could recommend an obligatory national register. Organisations of surgeons and governments should develop and establish these registers. Furthermore, an all-encompassing international register should be established by the European Union and the American FDA (Food and Drug Administration); this might be useful in comparing the individual country registers and also would help in delivering "evidence based" medicine in cosmetic and medical procedures. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Munhoz AM, Montag E, Filassi JR, Gemperli R. Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques. World J Clin Oncol 2014; 5:478-494. [PMID: 25114861 PMCID: PMC4127617 DOI: 10.5306/wjco.v5.i3.478] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/24/2014] [Accepted: 05/16/2014] [Indexed: 02/06/2023] Open
Abstract
Nipple-sparing mastectomy (NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon and careful preoperative and intraoperative management. In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon’s experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon’s experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to define consistent selection criteria for NSM.
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Sood S, Elder E, French J. Nipple-sparing mastectomy with implant reconstruction: the Westmead experience. ANZ J Surg 2014; 85:363-7. [DOI: 10.1111/ans.12641] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Samriti Sood
- Westmead Hospital; Westmead Breast Cancer Institute; Westmead New South Wales Australia
| | - Elisabeth Elder
- Westmead Hospital; Westmead Breast Cancer Institute; Westmead New South Wales Australia
- Department of Surgery; Westmead Private Hospital; Westmead New South Wales Australia
- Department of Surgery; Norwest Private Hospital; Sydney New South Wales Australia
| | - James French
- Westmead Hospital; Westmead Breast Cancer Institute; Westmead New South Wales Australia
- Department of Surgery; Westmead Private Hospital; Westmead New South Wales Australia
- Department of Surgery; Norwest Private Hospital; Sydney New South Wales Australia
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First international consensus guidelines for breast cancer in young women (BCY1). Breast 2014; 23:209-20. [PMID: 24767882 DOI: 10.1016/j.breast.2014.03.011] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/25/2014] [Accepted: 03/25/2014] [Indexed: 01/23/2023] Open
Abstract
The 1st International Consensus Conference for Breast Cancer in Young Women (BCY1) took place in November 2012, in Dublin, Ireland organized by the European School of Oncology (ESO). Consensus recommendations for management of breast cancer in young women were developed and areas of research priorities were identified. This manuscript summarizes these international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).
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Cypel TK, Brown M. Twelve-year delay of a nipple-sharing graft: A case report. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2014; 21:190-1. [PMID: 24421653 DOI: 10.1177/229255031302100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present report describes the use of a nipple-sharing technique for nipple areolar reconstruction using a donor nipple that was initially grafted from the contralateral and healthy breast 12 years earlier. There are many different techniques available to reconstruct the nipple. Although nipple sharing is not feasible to use in all patients, when available, it is an ideal approach for matching the contralateral nipple in terms of shape, colour, texture and long-term projection.
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Affiliation(s)
| | - Mitchell Brown
- Women's College Hospital; ; Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario
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Tukenmez M, Ozden BC, Agcaoglu O, Kecer M, Ozmen V, Muslumanoglu M, Igci A. Videoendoscopic single-port nipple-sparing mastectomy and immediate reconstruction. J Laparoendosc Adv Surg Tech A 2014; 24:77-82. [PMID: 24401140 DOI: 10.1089/lap.2013.0172] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Single-incision videoendoscopic surgery has recently become popular as a result of the ongoing search for less invasive procedures. The aim of this study was to evaluate the safety and efficacy of endoscopic single-port nipple-sparing mastectomy, axillary lymphadenectomy, and immediate reconstruction in patients with breast cancer. PATIENTS AND METHODS From May 14, 2012 through January 23, 2013, 10 patients underwent videoendoscopic single-port nipple-sparing mastectomy and axillary dissection via a single, limited incision and immediate prosthetic reconstruction. Patient charts were reviewed, and demographic data, operative time, complications and pathology results were analyzed. RESULTS In all patients, videoendoscopic surgery was performed successfully. Of 10 patients, 7 were diagnosed as having invasive ductal carcinoma, 2 had a ductal carcinoma in situ, and 1 underwent bilateral prophylactic mastectomy. The weight of the resected gland was 300-650 g, with a mean of 420 g. There were no operative complications, and the mean operative time was 250 minutes (range, 160-330 minutes). One-stage reconstruction with implants was performed on 4 patients, whereas expanders were placed in the remaining 6. Surgical margins of all cases were pathologically negative, and there were no recurrences observed during the early follow-up period. CONCLUSIONS Videoendoscopic single-port nipple-sparing mastectomy is technically feasible even in larger breasts, enabling immediate reconstruction with good cosmetic outcomes. However, further studies with larger clinical series and long-term follow-up are required to compare the safety and efficacy of the technique with those of the standard nipple-sparing mastectomy.
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Affiliation(s)
- Mustafa Tukenmez
- 1 Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey
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Fortunato L, Loreti A, Andrich R, Costarelli L, Amini M, Farina M, Santini E, Vitelli CE. When mastectomy is needed: Is the nipple-sparing procedure a new standard with very few contraindications? J Surg Oncol 2013; 108:207-12. [DOI: 10.1002/jso.23390] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 07/09/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Lucio Fortunato
- Breast Unit, Department of Surgery; San Giovanni-Addolorata Hospital; Rome Italy
| | - Andrea Loreti
- Breast Unit, Department of Surgery; San Giovanni-Addolorata Hospital; Rome Italy
| | - Renato Andrich
- Breast Unit, Department of Surgery; San Giovanni-Addolorata Hospital; Rome Italy
| | | | - Mostafà Amini
- Department of Pathology; San Giovanni-Addolorata Hospital; Rome Italy
| | - Massimo Farina
- Breast Unit, Department of Surgery; San Giovanni-Addolorata Hospital; Rome Italy
| | - Elena Santini
- Department of Radiology; San Giovanni-Addolorata Hospital; Rome Italy
| | - Carlo E. Vitelli
- Breast Unit, Department of Surgery; San Giovanni-Addolorata Hospital; Rome Italy
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Sakurai T, Zhang N, Suzuma T, Umemura T, Yoshimura G, Sakurai T, Yang Q. Long-term follow-up of nipple-sparing mastectomy without radiotherapy: a single center study at a Japanese institution. Med Oncol 2013; 30:481. [PMID: 23377926 DOI: 10.1007/s12032-013-0481-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
Abstract
Recent reports have suggested that nipple-sparing mastectomy (NSM) is a potential alternative to mastectomy (MT). The aim of our study was to investigate the oncological and technical outcomes of NSM compared with MT using long-term follow-up data. A total of 932 patients between April 1985 and March 2004 were enrolled in our study. Among them, 788 patients received NSM, whereas 144 patients received the routine mastectomy. The median follow-up time was 78 months. No significant difference in the probability of local recurrence between the NSM cohort and the MT cohort was found (8.2 vs. 7.6 %, p = 0.81). The rate of nipple-areola complex (NAC) relapse was low (3.7 %), and all of the nipple and/or areola recurrence cases were treated with NAC removal. Furthermore, nipple and/or areola recurrence was associated with a significantly better prognosis than that of skin flap recurrences and local lymph node recurrences. For the 21-year disease-free survival and the 21-year overall survival, no significant difference between the NSM and MT cohorts was observed. There was no occurrence of nipple necrosis in our trial. This was the first study to investigate the long-term follow-up of NSM in a large Japanese population. We reported the NSM could be performed without nipple necrosis and is oncologically as safe as mastectomy without radiotherapy. Therefore, we suggest that NSM without radiotherapy is a potential alternative to mastectomy for breast cancer patients for both outcome and aesthetic benefits.
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Bury S, Crosby M, Babiera GV. Nipple-sparing mastectomy: considerations and techniques. BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.12.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Nipple-sparing mastectomy (NSM) is the next step in the natural progression of tissue preservation breast cancer surgery. NSM selection criteria are a balance between oncologic and cosmetic considerations; accurate ascertainment of nipple involvement is critical. Further selection should be based on patients with the greatest likelihood of viable flaps and the ability to maintain symmetrical breasts. Surgical technique focuses on incision selection and creating thin flaps with removal of the majority of breast tissue. Risk assessment for long-term recurrence is necessary with proponents for pre-, intra- and post-operative assessment. Prospective studies show low rates of local recurrence of the nipple–areolar complex and are comparable to skin-sparing mastectomy with short-term follow-up in highly select groups of patients. Extended follow-up will be helpful in determining long-term outcomes. Nipple necrosis is an outcome that should be considered. Studies may support improved quality of life and patient satisfaction with NSM, and it is likely to be a safe and feasible procedure that may benefit carefully selected patients.
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Affiliation(s)
- Sean Bury
- The University of Texas Medical School at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Melissa Crosby
- The University of Texas MD Anderson Cancer Center, Department of Plastic Surgery, 1400 Hermann Pressler Drive, Unit 1488, Houston, TX 77030, USA
| | - Gildy V Babiera
- The University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, 1400 Hermann Pressler Drive, Unit 1484, Houston, TX 77030, USA
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Nikolic DV, Djordjevic ML, Granic M, Nikolic AT, Stanimirovic VV, Zdravkovic D, Jelic S. Importance of revealing a rare case of breast cancer in a female to male transsexual after bilateral mastectomy. World J Surg Oncol 2012; 10:280. [PMID: 23273269 PMCID: PMC3554459 DOI: 10.1186/1477-7819-10-280] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 11/26/2012] [Indexed: 12/20/2022] Open
Abstract
The incidence of breast carcinoma following prophylactic mastectomy is probably less than 2%. We present a 43-year-old female to male transsexual who developed breast cancer 1 year after bilateral nipple- sparing subcutaneous mastectomy as part of female to male gender reassignment surgery. In addition to gender reassignment surgery, total abdominal hysterectomy with bilateral salpingo-oophorectomy (to avoid the patient from entering menopause and to eliminate any subsequent risk of iatrogenic endometrial carcinoma), colpocleisys, metoidioplasty, phalloplasty, urethroplasty together with scrotoplasty/placement of testicular prosthesis and perineoplasty were also performed. Before the sex change surgery, the following diagnostic procedures were performed: breast ultrasound and mammography (which were normal), lung radiography (also normal) together with abdominal ultrasound examination, biochemical analysis of the blood and hormonal status. According to medical literature, in the last 50 years only three papers have been published with four cases of breast cancer in transsexual female to male patients. All hormonal pathways included in this complex hormonal and surgical procedure of transgender surgery have important implications for women undergoing prophylactic mastectomy because of a high risk of possible breast cancer.
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Affiliation(s)
- Dejan V Nikolic
- Faculty of Medicine, University of Belgrade, Dr,Subotica 8, 11000, Belgrade, Serbia.
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Murthy V, Chamberlain RS. Nipple-sparing mastectomy in modern breast practice. Clin Anat 2012; 26:56-65. [PMID: 23168689 DOI: 10.1002/ca.22185] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 09/20/2012] [Indexed: 12/30/2022]
Abstract
Breast cancer management has evolved from the conventional radical Halsted to a fully integrated multidisciplinary approach. Nipple sparing mastectomy (NSM) is an innovative technique that preserves native breast envelope without mutilation of nipple-areola complex (NAC), thus providing a reasonable alternative for early cancers without NAC involvement and prophylactic high risk patients and avoids multiple surgical procedures required for reconstruction. This article aims to critically review indications, intra-operative protocols, radiotherapy planning and limitations of NSM. Patient selection should be based on study of breast duct anatomy by Magnetic Resonance Imaging, mammographic tumor-nipple distance and obligatory intra-operative frozen section from retro-areolar tissue. Tumor size, axillary lymph node status, lymphovascular invasion and/or degree of intraductal component are factors used to include NSM candidates based on institutional practice. Given the heterogeneity of patients and lack of standardization of preoperative investigations, surgical technique and pathologic sampling of retro-areola tissue so far, mandates a multi-institutional prospective study to define and validate a role for NSM in invasive breast cancer and DCIS. Nipple necrosis is an important NSM complication which can be greatly reduced using alternative skin incisions. Even if the nipple survives, an insensate nipple and lack of sexual function is common and requires preoperative counseling and discussion. Finally the relation and timing of intra-operative versus adjuvant breast radiation and tailoring of dosage and delivery methods has not been fully explored. Although NSM reduces psychological trauma associated with nipple loss, the oncologic safety as well as functional and aesthetic outcomes needs additional investigation.
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Affiliation(s)
- Vijayashree Murthy
- Department of Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
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Cardoso F, Loibl S, Pagani O, Graziottin A, Panizza P, Martincich L, Gentilini O, Peccatori F, Fourquet A, Delaloge S, Marotti L, Penault-Llorca F, Kotti-Kitromilidou AM, Rodger A, Harbeck N. The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. Eur J Cancer 2012; 48:3355-77. [PMID: 23116682 DOI: 10.1016/j.ejca.2012.10.004] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 10/02/2012] [Accepted: 10/02/2012] [Indexed: 12/22/2022]
Abstract
EUSOMA (The European Society of Breast Cancer Specialists) is committed to writing recommendations on different topics of breast cancer care which can be easily adopted and used by health professionals dedicated to the care of patients with breast cancer in their daily practice. In 2011, EUSOMA identified the management of young women with breast cancer as one of the hot topics for which a consensus among European experts was needed. Therefore, the society recently organised a workshop to define such recommendations. Thirteen experts from the different disciplines met for two days to discuss the topic. This international and multidisciplinary panel thoroughly reviewed the literature in order to prepare evidence-based recommendations. During the meeting, two working groups were set up to discuss in detail diagnosis and loco-regional and systemic treatments, including both group aspects of psychology and sexuality. The conclusions reached by the working groups were then discussed in a plenary session to reach panel consensus. Whenever possible, a measure of the level of evidence (LoE) from 1 (the highest) to 4 (the lowest) degree, based on the methodology proposed by the US Agency for Healthcare Research and Quality (AHRQ), was assigned to each recommendation. The present manuscript presents the recommendations of this consensus group for the management of young women with breast cancer in daily clinical practice.
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Affiliation(s)
- Fatima Cardoso
- Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal.
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Lohsiriwat V, Rotmensz N, Botteri E, Intra M, Veronesi P, Martella S, Garusi C, De Lorenzi F, Manconi A, Lomeo G, Rietjens M, Schorr M, Kneubil MC, Petit JY. Do clinicopathological features of the cancer patient relate with nipple areolar complex necrosis in nipple-sparing mastectomy? Ann Surg Oncol 2012; 20:990-6. [PMID: 23070785 DOI: 10.1245/s10434-012-2677-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The selections of nipple-sparing mastectomy (NSM) are principally depending on oncologic indication and oncologic safety. The main complication of NSM is nipple areolar complex (NAC) necrosis, and it is usually related to surgical technique. However, the patients' clinicopathological factors should be also considered. METHOD We retrospectively reviewed 934 consecutive NSM patients during 2002-2007 at the European Institute of Oncology, Milan, Italy. We identified a group of patient who had NAC excision because of NAC necrosis and compared this group with those who had successful NAC conservation. We analyzed the association between the risk of NAC necrosis and the clinicopathological features of the patients. RESULTS Among 934 NSM, 772 were invasive cancers and 162 were in situ cancers. Of the 934, 40 NAC (4.2%) were removed during the postoperative period because of necrosis. When we considered age, BMI, menopausal status, smoking status, tumor size, axillary lymph node status, in situ or invasive cancer histology, presence of extensive situ component, grading, estrogen receptor, progesterone receptor, HER2/neu overexpression, Ki-67 proliferative index, and peritumoral vascular invasion, no association was observed between patients' clinicopathological features and NAC necrosis incidence. CONCLUSIONS In our study, clinicopathological features have no significant impact on necrosis complication in therapeutic NSMs. Positive retroareolar margin is the risk of necrosis. Further studies are required to avoid bias due to the different cancer treatments such as different reconstruction techniques and intraoperative radiation protocols. The correlation between breast morphology and NAC necrosis should also be investigated in the future.
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Affiliation(s)
- Visnu Lohsiriwat
- Division of Plastic Surgery, European Institute of Oncology, Milan, Italy.
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Oncologic safety of skin-sparing and nipple-sparing mastectomy: a discussion and review of the literature. Int J Surg Oncol 2012; 2012:921821. [PMID: 22848803 PMCID: PMC3405669 DOI: 10.1155/2012/921821] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 06/06/2012] [Accepted: 06/07/2012] [Indexed: 12/29/2022] Open
Abstract
Breast conservation therapy has been the cornerstone of the surgical treatment of breast cancer for the last 20 years; however, recently, the use of mastectomy has been increasing. Mastectomy is one of the most frequently performed breast operations, and with novel surgical techniques, preservation of the skin envelope and/or the nipple-areolar complex is commonly performed. The goal of this paper is to review the literature on skin-sparing mastectomy and nipple-sparing mastectomy and to evaluate the oncologic safety of these techniques. In addition, this paper will discuss the oncologic importance of margin status and type of mastectomy as it pertains to risk of local recurrence and relative need for adjuvant therapy.
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Why do women accept to undergo a nipple sparing mastectomy or to reconstruct the nipple areola complex when nipple sparing mastectomy is not possible? Breast Cancer Res Treat 2012; 132:1177-84. [PMID: 22350788 DOI: 10.1007/s10549-012-1983-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 01/31/2012] [Indexed: 10/28/2022]
Abstract
In a retrospective study, we investigated the reasons why women accepted to undergo a nipple sparing mastectomy (NSM) and why women who could not keep their nipple areola complex (NAC) decided to reconstruct it. We intended to investigate whether keeping the NAC plays a psychological role, to state possible advantages of NSM. Between 2004 and 2006, 310 women with NAC sparing and 143 patients with successive NAC reconstruction were mailed a single open-ended question at follow-up 12 months after final breast reconstruction surgery or final NAC reconstruction with tattoo. The purpose was to explore personal motivations that drove women to accept NSM or to perform a NAC tattoo reconstruction. Responses were classified into 11 categories by five reviewers. We performed an analysis of the relative frequency of emerging issues. Socio-demographic and clinical data were collected. Among the patients who responded to the open-ended question, 190 patients preserved their NAC, and 100 patients received postponed NAC reconstruction. Women in the NSM group were significantly younger (P = 0.02), more highly educated (P < 0.0001), and more frequently lived in Northern Italy (P = 0.03). The reasons for accepting NSM were more frequently related to body image satisfaction and integrity of the body (P = 0.002), reduction of psychological distress (P = 0.003), and surgeon's influence (P < 0.0001). Esthetic reasons were highly associated to the control group. These results help us to better understand the psychological impact of NAC sparing versus NAC reconstruction. NSM was accepted because it was perceived as a technique that preserved the integrity of the body, reduced the feeling of mutilation, improved the breast cosmetic results, and reduced psychological distress regarding the loss of the breast.
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Murthy V, Chamberlain RS. Defining a Place for Nipple Sparing Mastectomy in Modern Breast Care: An Evidence Based Review. Breast J 2012; 19:571-81. [PMID: 22284266 DOI: 10.1111/j.1524-4741.2011.01220.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Vijayashree Murthy
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJDepartment of Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ, USASaint George's University School of Medicine, Grenada, West Indies
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Abstract
Nipple-sparing mastectomy (NSM) is a surgical protocol designed to reduce the disabling psychological effects of radical or skin-sparing mastectomy. The preservation of the nipple-areola complex produces a more-natural result of the breast reconstruction, but this preservation is suspected of increasing tumor local recurrence. To reduce this risk, different approaches have been proposed: restrict the inclusion criteria and/or add localized radiation therapy. The local recurrence rate in recent series of patients receiving NSM is comparable with the local recurrence rate in modified radical or skin-sparing mastectomies. Today, the quality of the subcutaneous mastectomy technique allows for a more radical glandular removal, especially in the retroareolar area; therefore, local recurrence is observed in 3-6% of patients at 5 years, consistent with traditional mastectomy.
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Nipple-areola complex sparing mastectomy with periareolar pexy for breast cancer patients with moderately ptotic breasts. J Plast Reconstr Aesthet Surg 2011; 65:296-303. [PMID: 22000331 DOI: 10.1016/j.bjps.2011.09.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 08/06/2011] [Accepted: 09/17/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nipple-areola complex sparing mastectomy (NSM) with immediate implant reconstruction has been recently introduced for breast cancer patients who are not candidates for breast preserving surgery. As the cosmetic results in moderately ptotic breasts may not be optimal, a modified NSM with a periareolar pexy (PP-NSM) was introduced at our Institution. Patients selection criteria and complication rates of PP-NSM were prospectively recorded and compared with those of the classical NSM. RESULTS Over a period of 11 months, 22 PP-NSMs and 35 NSMs were performed. The mean jugular-nipple distance was significantly longer in the PP-NSM as compared with the NSM (22.6 vs. 19.6 cm; p=0.000), whereas the mean inframammary fold-areola distance was superimposable (5.4 cm). The periareolar mastopexy led to a mean cranial transposition of the nipple-areola complex (NAC) of 2.2 cm (range 1.5-4 cm). Mean breast weight was significantly higher in the PP-NSM as compared with the NSM cohort (336 vs. 236 g; p=0.003). The only case of total NAC necrosis occurred in the PP-NSM group. Partial NAC necrosis was slightly more frequent in the PP-NSM than in the NSM group (13.6% vs. 2.9%%; p=n.s.), possibly due to the higher percentage of smokers (41.0% vs. 14.0%; p=0.05). Early cosmetic results were good to excellent from the surgeon's and the patient's point of view in over 80% of the cases. CONCLUSIONS PP-NSM allows good cosmetic results and low complication rates in patients with moderately ptotic breasts requiring a mastectomy. In particular, PP-NSM seems to be a good option for women at high risk for developing breast cancer and for selected patients affected by non-locally advanced breast cancer.
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